The field of art to which this invention relates is medical devices, more specifically, medical devices and surgical procedures for performing anastomosis of hollow organs such as blood vessels.
Anastomosis surgical procedures are common in the field of cardiac surgery. These procedures are conventionally used for repairing a damaged or diseased blood vessel. In a typical anastomosis procedure, a surgeon joins a first blood vessel to a second blood vessel and creates a passageway between the two blood vessels to provide for the communication of blood flow. For this kind of anastomosis, the surgeon typically uses specialized grasping tools to manipulate a tiny, curved needle attached to an extremely fine surgical filament (under 0.001 inch diameter) to suture the vessels together. The vessels may be joined end-to-end, end-to-side, or side-to-side. To facilitate healing of the joined vessels, the prevailing standard of care requires that the surgeon suture the inside surfaces of the first and second vessels together, intima to intima. The surgeon must take great care not to damage the intima of each vessel so that endothelial cells may form over the anastomosis without the formation of thrombus or other complications, thus improving the likelihood of a long term patency of the vessels. For life-saving procedures such as coronary artery bypass graft surgery (CABG), this is especially important. When performing a distal anastomosis in a conventional CABG procedure, the surgeon typically sutures an end-to-side anastomosis of a distal end of a graft vessel (such as a segment of saphenous vein harvested from the patient) to a side of a target vessel (the stenosed coronary artery). For a proximal anastomosis in a conventional CABG procedure, the surgeon sutures a proximal end of the graft vessel to the side of the aorta.
As this field of art has progressed over the last several years, new anastomotic methods have been developed and introduced in attempts to replace the suturing technique briefly described above. Many of these methods incorporate novel fasteners and fastener appliers. The requirement, however, to maintain intima-to-intima contact of the joined vessels remains just as important with these approaches. In fact it is often necessary, prior to joining the vessels, for the surgeon to evert (i.e., turn inside out) the end of at least one of the vessels over the end of a member such as a tube, ferrule, or bushing, etc., which is a component of the fastener or fastener applier. This exposes the intima of that vessel for presentation to the intima of the other vessel prior to fastening the vessels.
Although it is possible to evert larger vessels (over 5 mm in diameter) using standard forceps and graspers available in the operating room, such methods are slow and may result in excessive damage to the vessel everted. And, often the surgeon requires assistance in performing the eversion procedure. Furthermore, vessels smaller than 5 mm are very difficult, if not impossible, to evert using such methods.
There are several requirements for an effective vessel eversion device. As noted earlier, for proper healing, it is important not to injure the intima of either vessel during the eversion procedure. The eversion device also must be easy for the surgeon to use without assistance and require only a few steps to operate. The eversion device must be useful for a wide range of blood vessel sizes, particularly small vessels, e.g., having a diameter of about 2-3 mm or less. In addition, it is desirable for the eversion device to be useful on one end of a vessel when the opposite end is already attached to the patient (e.g., at the distal anastomosis of a patient undergoing a CABG procedure). The eversion device should also allow for the proper length of everted tissue, depending on the requirements of the anastomosis device or method to be used. Finally, it is desirable that the eversion device is low cost and yet operates reliably.
Accordingly, there is a need in this art for novel devices and methods for engaging and everting the end of a blood vessel (or other tubular body organ) which can be used in a quick and effective manner without causing trauma to the vessel or the intima of the vessel (or tubular body organ).
It is an object of the present invention to provide novel eversion devices which are easy for the surgeon to use without assistance, and which efficiently and effectively engage blood vessels and evert the ends of blood vessels, including blood vessels having small or fine diameters.
A further object of the present invention is to provide novel eversion devices that engage blood vessels and evert the ends of blood vessels without causing trauma to the blood vessel or the intima of the blood vessels.
It is yet another object of the present invention to provide novel methods of engaging and everting blood vessels quickly and efficiently, while preventing or minimizing damage to the blood vessels and the intimas of the blood vessels.
It is still yet a further object of the present invention to provide a novel vessel eversion device and procedure for everting one end of a vessel having the other end already attached to another vessel.
Accordingly, an eversion instrument for everting an end of a vessel is disclosed.
The instrument has a handle member. There is a curved mandrel member having a proximal end, a distal end, an outer surface and a longitudinal axis. The proximal end of the mandrel member is mounted to the handle member, while the distal end and at least a distal section of the curved mandrel member are insertable to a predetermined depth into the lumen of a vessel contained in the bore of a workpiece having a bore and an inner surface surrounding the bore. The outer surface of the curved mandrel member engages a vessel against the bore surface of the workpiece at three spaced-apart contact regions when the curved mandrel member is inserted into the bore of the workpiece to the predetermined depth
Yet another aspect of the claimed invention is a method of everting a vessel. A tubular workpiece is provided. The tubular workpiece has a tubular member having a proximal end, a distal end, an inner bore, an inner surface surrounding the inner bore, and an outer surface. A body vessel, such as a blood vessel, having at least a first end is provided. At least a section of the vessel is placed into the bore of the tubular member. An eversion instrument is provided. The instrument has a handle member. The instrument also has a curved mandrel member having a proximal end, a distal end, an outer surface and a longitudinal axis. The proximal end of the mandrel member is mounted to the handle member. The distal end of the curved mandrel member is insertable to a predetermined depth into the lumen of the vessel contained in the bore of the tubular member, wherein the outer surface of the curved mandrel member engages the vessel against the inner surface of the tubular member at three spaced-apart contact regions when said curved mandrel member is inserted into the vessel lumen and bore to the predetermined depth. At least a distal section of the mandrel member is inserted into the lumen of the vessel contained in the bore of the tubular member and the vessel is engaged against the inner surface of the tubular member by the outer surface of the mandrel member at three spaced-apart contact regions. The end of the vessel is invaginated over the distal end of the tubular member and onto the outer surface of the distal end of the tubular member. Then, the curved mandrel member of said eversion instrument is removed from the lumen of the vessel and the bore of the tubular member, thereby providing an everted end of the vessel.
These and other aspects and advantages of the present invention will become more apparent from the following description and accompanying drawings.